H SUBSTITUTE HOUSE BILL State of Washington 60th Legislature 2007 Regular Session

Transcription

1 H SUBSTITUTE HOUSE BILL 2098 State of Washington 60th Legislature 2007 Regular Session By House Committee on Health Care & Wellness (originally sponsored by Representatives Cody, Upthegrove, Morrell, Kenney, Conway, Simpson, Hudgins and Ormsby; by request of Governor Gregoire) READ FIRST TIME 02/21/07. 1 AN ACT Relating to providing high quality, affordable health care 2 to Washingtonians based on the recommendations of the blue ribbon 3 commission on health care costs and access; amending RCW , , and ; adding new sections to chapter RCW; 5 adding a new section to chapter RCW; adding a new section to 6 chapter RCW; adding a new section to chapter RCW; adding a 7 new section to chapter RCW; adding a new section to chapter RCW; adding a new section to chapter RCW; adding a new section to 9 chapter RCW; creating new sections; and providing an effective 10 date. 11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON: 12 USE STATE PURCHASING TO IMPROVE HEALTH CARE QUALITY 13 NEW SECTION. Sec. 1. The health care authority and the department 14 of social and health services shall, by September 1, 2007, develop a 15 five-year plan to change reimbursement within state purchased health 16 care programs to: 17 (1) Reward quality health outcomes rather than simply paying for 18 the receipt of particular services or procedures; p. 1 SHB 2098

2 1 (2) Pay for care that reflects patient preference and is of proven 2 value; 3 (3) Require the use of evidence-based standards of care where 4 available; 5 (4) Tie provider rate increases to measurable improvements in 6 access to quality care; 7 (5) Direct enrollees to quality care systems; 8 (6) Better support primary care and provide a medical home to all 9 enrollees; and 10 (7) Pay for consultations, telemedicine, and telehealth 11 where doing so reduces the overall cost of care. 12 The plan shall identify any existing barriers and opportunities to 13 support implementation, including needed changes to state or federal 14 law and be submitted to the governor and the legislature upon 15 completion. 16 NEW SECTION. Sec. 2. A new section is added to chapter RCW 17 to read as follows: 18 (1) The health care authority shall implement a pilot for shared 19 decision making for common medical decisions. The authority shall 20 select or create not more than two patient decision aids in 21 collaboration with the state agency medical directors group. Criteria 22 for selection of the patient decision aids shall include common medical 23 decisions which have no more than five treatment options, and where 24 there exists sound evidence about medical effectiveness. 25 (2) The authority shall seek up to two contracts with provider 26 organizations or health carriers to pilot the use of patient decision 27 aids. These contracts shall require an evaluation of the resulting 28 outcomes of utilizing the patient decision aids. The authority shall 29 provide a report to the governor and the legislature on the pilot 30 results by June 30, (3) For purposes of this section: 32 (a) "Patient decision aid" means: (i) High quality, up-to-date 33 information about the condition, including risk and benefits of 34 available options and, if appropriate, a discussion of the limits of 35 scientific knowledge about outcomes; (ii) values clarification to help 36 patients sort out their values and preferences; and (iii) guidance or SHB 2098 p. 2

3 1 coaching in deliberation, designed to improve the patient's involvement 2 in the decision process; and 3 (b) "Shared decision making" means a process in which the physician 4 discloses to the patient the risks and benefits associated with all 5 treatment alternatives, including no treatment, that a reasonable 6 person in the patient's situation could consider significant in 7 selecting a particular path of medical care. The patient then shares 8 with the physician all relevant personal information that might make 9 one treatment or side effect more or less desirable than others. 10 PREVENTION AND MANAGEMENT OF CHRONIC ILLNESS 11 NEW SECTION. Sec. 3. A new section is added to chapter RCW 12 to read as follows: 13 (1) The department of social and health services, in collaboration 14 with the department of health, shall: 15 (a) Design and implement medical homes for its aged, blind, and 16 disabled clients in conjunction with chronic care management programs 17 to improve health outcomes, access, and cost-effectiveness. Programs 18 must be evidence based, facilitating the use of information technology 19 to improve quality of care, and must improve coordination of primary, 20 acute, and long-term care for those clients with multiple chronic 21 conditions. The department shall consider expansion of existing 22 medical home and chronic care management programs and build on the 23 Washington state collaborative initiative. The department shall use 24 best practices in identifying those clients best served under a chronic 25 care management model using predictive modeling through claims or other 26 health risk information; and 27 (b) Evaluate the effectiveness of the intensive chronic care 28 management pilot project that manages the needs of long-term care 29 clients with multiple chronic conditions and the department's chronic 30 care management program to determine if the models support medical home 31 infrastructure and improved client outcomes. 32 (2) For purposes of this section: 33 (a) "Medical home" means a site of care that provides comprehensive 34 preventive and coordinated care centered on the patient needs and 35 assures high quality, accessible, and efficient care. p. 3 SHB 2098

4 1 (b) "Chronic care management" means the department's program that 2 provides care management and coordination activities for medical 3 assistance clients determined to be at risk for high medical costs. 4 "Chronic care management" provides education and training and/or 5 coordination that assist program participants in improving self- 6 management skills to improve health outcomes and reduce medical costs 7 by educating clients to better utilize services. 8 NEW SECTION. Sec. 4. A new section is added to chapter RCW 9 to read as follows: 10 (1) The department shall conduct a program of training and 11 technical assistance regarding care of people with chronic conditions 12 for providers of primary care. The program shall emphasize evidence- 13 based high quality preventive and chronic disease care. The department 14 may designate one or more chronic conditions to be the subject of the 15 program. 16 (2) The training and technical assistance program shall include the 17 following elements: 18 (a) Clinical information systems and sharing and organization of 19 patient data; 20 (b) Decision support to promote evidence-based care; 21 (c) Clinical delivery system design; 22 (d) Support for patients managing their own conditions; and 23 (e) Identification and use of community resources that are 24 available in the community for patients and their families. 25 (3) In selecting primary care providers to participate in the 26 program, the department shall consider the number and type of patients 27 with chronic conditions the provider serves, and the provider's 28 participation in the medicaid and medicare programs. 29 COST AND QUALITY INFORMATION FOR CONSUMERS AND PROVIDERS 30 NEW SECTION. Sec. 5. A new section is added to chapter RCW 31 to read as follows: 32 The Washington state quality forum is established within the 33 authority. The forum shall collaborate with the Puget Sound health 34 alliance and other local organizations and shall: SHB 2098 p. 4

5 1 (1) Collect and disseminate research regarding health care quality, 2 evidence-based medicine, and patient safety to promote best practices, 3 in collaboration with the technology assessment program and the 4 prescription drug program; 5 (2) Coordinate the collection of health care quality data among 6 state health care purchasing agencies; 7 (3) Adopt a set of measures to evaluate and compare health care 8 cost and quality and provider performance; 9 (4) Identify and disseminate information regarding variations in 10 clinical practice patterns across the state; and 11 (5) Produce an annual quality report detailing clinical practice 12 patterns identified to purchasers, providers, insurers, and policy 13 makers. 14 NEW SECTION. Sec. 6. A new section is added to chapter RCW 15 to read as follows: 16 (1) The administrator shall design and pilot a consumer-centric 17 health information infrastructure and the first health record banks 18 that will facilitate the secure exchange of health information when and 19 where needed and shall: 20 (a) Complete the plan of initial implementation, including but not 21 limited to determining the technical infrastructure for health record 22 banks and the account locator service, setting criteria and standards 23 for health record banks, and determining oversight of health record 24 banks; 25 (b) Implement the first health record banks in pilot sites as 26 funding allows; 27 (c) Involve health care consumers in meaningful ways in the design, 28 implementation, oversight, and dissemination of information on the 29 health record bank system; and 30 (d) Promote adoption of electronic medical records and health 31 information exchange through continuation of the Washington health 32 information collaborative, and by working with private payors and other 33 organizations in restructuring reimbursement to provide incentives for 34 providers to adopt electronic medical records in their practices. 35 (2) The administrator may establish an advisory board, a 36 stakeholder committee, and subcommittees to assist in carrying out the 37 duties under this section. The administrator may reappoint health p. 5 SHB 2098

6 1 information infrastructure advisory board members to assure continuity 2 and shall appoint any additional representatives that may be required 3 for their expertise and experience. 4 (a) The administrator shall appoint the chair of the advisory 5 board, chairs, and cochairs of the stakeholder committee, if formed; 6 (b) Meetings of the board, stakeholder committee, and any advisory 7 group are subject to chapter RCW, the open public meetings act, 8 including RCW (1)(l), which authorizes an executive session 9 during a regular or special meeting to consider proprietary or 10 confidential nonpublished information; and 11 (c) The members of the board, stakeholder committee, and any 12 advisory group: 13 (i) Shall agree to the terms and conditions imposed by the 14 administrator regarding conflicts of interest as a condition of 15 appointment; 16 (ii) Are immune from civil liability for any official acts 17 performed in good faith as members of the board, stakeholder committee, 18 or any advisory group. 19 (3) Members of the board may be compensated in accordance with a 20 personal services contract to be executed after appointment and before 21 commencement of activities related to the work of the board. Members 22 of the stakeholder committee shall not receive compensation but shall 23 be reimbursed under RCW and (4) The administrator may work with public and private entities to 25 develop and encourage the use of personal health records which are 26 portable, interoperable, secure, and respectful of patients' privacy. 27 (5) The administrator may enter into contracts to issue, 28 distribute, and administer grants that are necessary or proper to carry 29 out this section. 30 REDUCING UNNECESSARY EMERGENCY ROOM USE 31 Sec. 7. RCW and 1998 c 245 s 38 are each amended to read 32 as follows: 33 (1) State general funds appropriated to the department of health 34 for the purposes of funding community health centers to provide primary 35 health and dental care services, migrant health services, and maternity 36 health care services shall be transferred to the state health care SHB 2098 p. 6

7 1 authority. Any related administrative funds expended by the department 2 of health for this purpose shall also be transferred to the health care 3 authority. The health care authority shall exclusively expend these 4 funds through contracts with community health centers to provide 5 primary health and dental care services, migrant health services, and 6 maternity health care services. The administrator of the health care 7 authority shall establish requirements necessary to assure community 8 health centers provide quality health care services that are 9 appropriate and effective and are delivered in a cost-efficient manner. 10 The administrator shall further assure that community health centers 11 have appropriate referral arrangements for acute care and medical 12 specialty services not provided by the community health centers. 13 (2) The authority, in consultation with the department of health, 14 shall work with community and migrant health clinics and other 15 providers of care to underserved populations, to ensure that the number 16 of people of color and underserved people receiving access to managed 17 care is expanded in proportion to need, based upon demographic data. 18 (3) In contracting with community health centers to provide primary 19 health and dental services, migrant health services, and maternity 20 health care services under subsection (1) of this section the authority 21 shall give priority to those community health centers working with 22 local hospitals to successfully reduce unnecessary emergency room use. 23 NEW SECTION. Sec. 8. The Washington state health care authority 24 and the department of social and health services shall report to the 25 legislature by December 1, 2007, on recent trends in unnecessary 26 emergency room use by enrollees in state purchased health care 27 programs, and then partner with community organizations and local 28 health care providers to design a demonstration pilot to reduce such 29 unnecessary visits. 30 REDUCE HEALTH CARE ADMINISTRATIVE COSTS 31 NEW SECTION. Sec. 9. By September 1, 2007, the insurance 32 commissioner shall provide a report to the governor and the legislature 33 that identifies the key contributors to health care administrative 34 costs and evaluates opportunities to reduce them, including suggested p. 7 SHB 2098

8 1 changes to state law. The report shall be completed in collaboration 2 with health care providers, carriers, state health purchasing agencies, 3 the Washington healthcare forum, and other interested parties. 4 COVERAGE FOR DEPENDENTS TO AGE TWENTY-FIVE 5 NEW SECTION. Sec. 10. A new section is added to chapter RCW 6 to read as follows: 7 (1) Any plan offered to public employees under this chapter must 8 offer each public employee the option of covering any unmarried 9 dependent of the employee under the age of twenty-five regardless of 10 whether the dependent is enrolled in an educational institution. 11 (2) Any employee choosing under subsection (1) of this section to 12 cover a dependent who is: (a) Age twenty through twenty-three and not 13 a registered student at an accredited secondary school, college, 14 university, vocational school, or school of nursing; or (b) age twenty- 15 four, shall be required to pay the full cost of such coverage. 16 NEW SECTION. Sec. 11. A new section is added to chapter RCW 17 to read as follows: 18 Any disability insurance contract that provides coverage for a 19 subscriber's dependent must offer the option of covering any unmarried 20 dependent under the age of twenty-five regardless of whether the 21 dependent is enrolled in an educational institution. 22 NEW SECTION. Sec. 12. A new section is added to chapter RCW 23 to read as follows: 24 Any group disability insurance contract or blanket disability 25 insurance contract that provides coverage for a participating member's 26 dependent must offer each participating member the option of covering 27 any unmarried dependent under the age of twenty-five regardless of 28 whether the dependent is enrolled in an educational institution. 29 NEW SECTION. Sec. 13. A new section is added to chapter RCW 30 to read as follows: 31 (1) Any individual health care service plan contract that provides 32 coverage for a subscriber's dependent must offer the option of covering SHB 2098 p. 8

9 1 any unmarried dependent under the age of twenty-five regardless of 2 whether the dependent is enrolled in an educational institution. 3 (2) Any group health care service plan contract that provides 4 coverage for a participating member's dependent must offer each 5 participating member the option of covering any unmarried dependent 6 under the age of twenty-five regardless of whether the dependent is 7 enrolled in an educational institution. 8 NEW SECTION. Sec. 14. A new section is added to chapter RCW 9 to read as follows: 10 (1) Any individual health maintenance agreement that provides 11 coverage for a subscriber's dependent must offer the option of covering 12 any unmarried dependent under the age of twenty-five regardless of 13 whether the dependent is enrolled in an educational institution. 14 (2) Any group health maintenance agreement that provides coverage 15 for a participating member's dependent must offer each participating 16 member the option of covering any unmarried dependent under the age of 17 twenty-five regardless of whether the dependent is enrolled in an 18 educational institution. 19 SUSTAINABILITY AND ACCESS TO PUBLIC PROGRAMS 20 NEW SECTION. Sec. 15. (1) The department of social and health 21 services shall seek necessary federal waivers and state plan amendments 22 to expand coverage and leverage federal and state resources for the 23 state's basic health program, for the medical assistance program, as 24 codified at Title XIX of the federal social security act, and the 25 state's children's health insurance program, as codified at Title XXI 26 of the federal social security act. The department shall propose 27 options including but not limited to: 28 (a) Offering alternative benefit designs to promote high quality 29 care, improve health outcomes, and encourage cost-effective treatment 30 options, including benefit designs that discourage the use of emergency 31 rooms for nonemergent care, and redirect savings to finance additional 32 coverage; and 33 (b) Promoting private health insurance plans and premium subsidies 34 to purchase employer-sponsored insurance wherever possible, including p. 9 SHB 2098

10 1 federal approval to expand the department's employer-sponsored 2 insurance premium assistance program to enrollees covered through the 3 state's children's health insurance program. 4 (2) The department of social and health services, in collaboration 5 with the Washington state health care authority, shall ensure that 6 enrollees are not simultaneously enrolled in the state's basic health 7 program and the medical assistance program or the state's children's 8 health insurance program to ensure coverage for the maximum number of 9 people within available funds. Priority enrollment in the basic health 10 program shall be given to those who disenrolled from the program in 11 order to enroll in medicaid, and subsequently became ineligible for 12 medicaid coverage. 13 NEW SECTION. Sec. 16. A new section is added to chapter RCW 14 to read as follows: 15 When the department of social and health services determines that 16 it is cost-effective to enroll a person eligible for medical assistance 17 under chapter RCW in an employer-sponsored health plan, a carrier 18 shall permit the enrollment of the person in the health plan for which 19 he or she is otherwise eligible without regard to any open enrollment 20 period restrictions. 21 REINSURANCE 22 NEW SECTION. Sec. 17. (1) The office of financial management, in 23 collaboration with the office of the insurance commissioner, shall 24 design a state-supported reinsurance program to address the impact of 25 high cost enrollees in the individual and small group health insurance 26 markets, and submit implementing legislation and supporting 27 information, including financing options, to the governor and the 28 legislature by December 1, In designing the program, the office 29 of financial management shall: 30 (a) Estimate the quantitative impact on premium savings, premium 31 stability over time and across groups of enrollees, individual and 32 employer take-up, number of uninsured, and government costs associated 33 with a government-funded stop-loss insurance program, including 34 distinguishing between one-time premium savings and savings in 35 subsequent years; SHB 2098 p. 10

11 1 (b) Identify all relevant design issues and alternative options for 2 each issue. Where quantitative impacts cannot be estimated, the office 3 of financial management shall assess qualitative impacts of design 4 issues and their options, including potential disincentives for 5 reducing premiums, achieving premium stability, sustaining/increasing 6 take-up, decreasing the number of uninsured, and managing government's 7 stop-loss insurance costs; 8 (c) Identify market and regulatory changes needed to maximize the 9 chance of the program achieving its policy goals, including how the 10 program will relate to other coverage programs and markets; 11 (d) Address conditions under which overall expenditures could 12 increase as a result of a government-funded stop-loss program and 13 options to mitigate those conditions, such as passive versus aggressive 14 use of disease and care management programs by insurers; 15 (e) Evaluate, and quantify where possible, the behavioral responses 16 of insurers to the program including impacts on insurer premiums and 17 practices for settling legal disputes around large claims; and 18 (f) Provide alternatives for transitioning from the status quo and, 19 where applicable, alternatives for phasing in some design elements, 20 such as threshold or corridor levels, to balance government costs and 21 premium savings. 22 (2) Within funds specifically appropriated for this purpose, the 23 office of financial management may contract with actuaries and other 24 experts as necessary to meet the requirements of this section. 25 THE WASHINGTON STATE HEALTH INSURANCE POOL 26 Sec. 18. RCW and 2001 c 196 s 4 are each amended to read 27 as follows: 28 (1) The pool shall offer one or more care management plans of 29 coverage. Such plans may, but are not required to, include point of 30 service features that permit participants to receive in-network 31 benefits or out-of-network benefits subject to differential cost 32 shares. ((Covered persons enrolled in the pool on January 1, 2001, may 33 continue coverage under the pool plan in which they are enrolled on 34 that date. However,)) The pool may incorporate managed care features 35 and requirements to participate in chronic care and disease management 36 and evidence-based protocols into ((such)) existing plans. p. 11 SHB 2098

12 1 (2) The administrator shall prepare a brochure outlining the 2 benefits and exclusions of ((the)) pool ((policy)) policies in plain 3 language. After approval by the board, such brochure shall be made 4 reasonably available to participants or potential participants. 5 (3) The health insurance ((policy)) policies issued by the pool 6 shall pay only reasonable amounts for medically necessary eligible 7 health care services rendered or furnished for the diagnosis or 8 treatment of covered illnesses, injuries, and conditions ((which are 9 not otherwise limited or excluded)). Eligible expenses are the 10 reasonable amounts for the health care services and items for which 11 benefits are extended under ((the)) a pool policy. ((Such benefits 12 shall at minimum include, but not be limited to, the following services 13 or related items)) 14 (4) The pool shall offer at least one policy which at a minimum 15 includes, but is not limited to, the following services or related 16 items: 17 (a) Hospital services, including charges for the most common 18 semiprivate room, for the most common private room if semiprivate rooms 19 do not exist in the health care facility, or for the private room if 20 medically necessary, but limited to a total of one hundred eighty 21 inpatient days in a calendar year, and limited to thirty days inpatient 22 care for mental and nervous conditions, or alcohol, drug, or chemical 23 dependency or abuse per calendar year; 24 (b) Professional services including surgery for the treatment of 25 injuries, illnesses, or conditions, other than dental, which are 26 rendered by a health care provider, or at the direction of a health 27 care provider, by a staff of registered or licensed practical nurses, 28 or other health care providers; 29 (c) The first twenty outpatient professional visits for the 30 diagnosis or treatment of one or more mental or nervous conditions or 31 alcohol, drug, or chemical dependency or abuse rendered during a 32 calendar year by one or more physicians, psychologists, or community 33 mental health professionals, or, at the direction of a physician, by 34 other qualified licensed health care practitioners, in the case of 35 mental or nervous conditions, and rendered by a state certified 36 chemical dependency program approved under chapter 70.96A RCW, in the 37 case of alcohol, drug, or chemical dependency or abuse; 38 (d) Drugs and contraceptive devices requiring a prescription; SHB 2098 p. 12

13 1 (e) Services of a skilled nursing facility, excluding custodial and 2 convalescent care, for not more than one hundred days in a calendar 3 year as prescribed by a physician; 4 (f) Services of a home health agency; 5 (g) Chemotherapy, radioisotope, radiation, and nuclear medicine 6 therapy; 7 (h) Oxygen; 8 (i) Anesthesia services; 9 (j) Prostheses, other than dental; 10 (k) Durable medical equipment which has no personal use in the 11 absence of the condition for which prescribed; 12 (l) Diagnostic x-rays and laboratory tests; 13 (m) Oral surgery limited to the following: Fractures of facial 14 bones; excisions of mandibular joints, lesions of the mouth, lip, or 15 tongue, tumors, or cysts excluding treatment for temporomandibular 16 joints; incision of accessory sinuses, mouth salivary glands or ducts; 17 dislocations of the jaw; plastic reconstruction or repair of traumatic 18 injuries occurring while covered under the pool; and excision of 19 impacted wisdom teeth; 20 (n) Maternity care services; 21 (o) Services of a physical therapist and services of a speech 22 therapist; 23 (p) Hospice services; 24 (q) Professional ambulance service to the nearest health care 25 facility qualified to treat the illness or injury; and 26 (r) Other medical equipment, services, or supplies required by 27 physician's orders and medically necessary and consistent with the 28 diagnosis, treatment, and condition. 29 (((4))) (5) The pool shall offer at least one policy which closely 30 adheres to benefits available in the private, individual market. 31 (6) The board shall design and employ cost containment measures and 32 requirements such as, but not limited to, care coordination, provider 33 network limitations, preadmission certification, and concurrent 34 inpatient review which may make the pool more cost-effective. 35 (((5))) (7) The pool benefit policy may contain benefit 36 limitations, exceptions, and cost shares such as copayments, 37 coinsurance, and deductibles that are consistent with managed care 38 products, except that differential cost shares may be adopted by the p. 13 SHB 2098

14 1 board for nonnetwork providers under point of service plans. The pool 2 benefit policy cost shares and limitations must be consistent with 3 those that are generally included in health plans approved by the 4 insurance commissioner; however, no limitation, exception, or reduction 5 may be used that would exclude coverage for any disease, illness, or 6 injury. 7 (((6))) (8) The pool may not reject an individual for health plan 8 coverage based upon preexisting conditions of the individual or deny, 9 exclude, or otherwise limit coverage for an individual's preexisting 10 health conditions; except that it shall impose a six-month benefit 11 waiting period for preexisting conditions for which medical advice was 12 given, for which a health care provider recommended or provided 13 treatment, or for which a prudent layperson would have sought advice or 14 treatment, within six months before the effective date of coverage. 15 The preexisting condition waiting period shall not apply to prenatal 16 care services. The pool may not avoid the requirements of this section 17 through the creation of a new rate classification or the modification 18 of an existing rate classification. Credit against the waiting period 19 shall be as provided in subsection (((7))) (9) of this section. 20 (((7))) (9)(a) Except as provided in (b) of this subsection, the 21 pool shall credit any preexisting condition waiting period in its plans 22 for a person who was enrolled at any time during the sixty-three day 23 period immediately preceding the date of application for the new pool 24 plan. For the person previously enrolled in a group health benefit 25 plan, the pool must credit the aggregate of all periods of preceding 26 coverage not separated by more than sixty-three days toward the waiting 27 period of the new health plan. For the person previously enrolled in 28 an individual health benefit plan other than a catastrophic health 29 plan, the pool must credit the period of coverage the person was 30 continuously covered under the immediately preceding health plan toward 31 the waiting period of the new health plan. For the purposes of this 32 subsection, a preceding health plan includes an employer-provided self- 33 funded health plan. 34 (b) The pool shall waive any preexisting condition waiting period 35 for a person who is an eligible individual as defined in section (b) of the federal health insurance portability and accountability 37 act of 1996 (42 U.S.C. 300gg-41(b)). SHB 2098 p. 14

15 1 (((8))) (10) If an application is made for the pool policy as a 2 result of rejection by a carrier, then the date of application to the 3 carrier, rather than to the pool, should govern for purposes of 4 determining preexisting condition credit. 5 (11) The pool shall contract with organizations that provide care 6 management that has been demonstrated to be effective and shall require 7 that enrollees who are eligible for care management services 8 participate in such programs on a continuous basis as a condition of 9 receiving pool coverage. 10 PREVENTION AND HEALTH PROMOTION 11 NEW SECTION. Sec. 19. The Washington state health care authority, 12 the department of social and health services, the department of labor 13 and industries, and the department of health shall, by September 1, , develop a five-year plan to integrate disease and accident 15 prevention and health promotion into state health programs by: 16 (1) Structuring benefits and reimbursements to promote healthy 17 choices and disease and accident prevention; 18 (2) Requiring enrollees in state health programs to complete a 19 health assessment, and providing appropriate follow up; 20 (3) Reimbursing for cost-effective prevention activities; 21 (4) Developing prevention and health promotion contracting 22 standards for state programs that contract with health carriers; and 23 (5) Strengthening the state's employee wellness program in 24 partnership with the state's health and productivity committee. 25 The plan shall identify any existing barriers and opportunities to 26 support implementation, including needed changes to state or federal 27 law, and be submitted to the governor and the legislature upon 28 completion. 29 Sec. 20. RCW and 2006 c 299 s 2 are each amended to read 30 as follows: 31 (1) The board shall study all matters connected with the provision 32 of health care coverage, life insurance, liability insurance, 33 accidental death and dismemberment insurance, and disability income 34 insurance or any of, or a combination of, the enumerated types of p. 15 SHB 2098

16 1 insurance for employees and their dependents on the best basis possible 2 with relation both to the welfare of the employees and to the state. 3 However, liability insurance shall not be made available to dependents. 4 (2) The board shall develop employee benefit plans that include 5 comprehensive health care benefits for all employees. In developing 6 these plans, the board shall consider the following elements: 7 (a) Methods of maximizing cost containment while ensuring access to 8 quality health care; 9 (b) Development of provider arrangements that encourage cost 10 containment and ensure access to quality care, including but not 11 limited to prepaid delivery systems and prospective payment methods; 12 (c) Wellness incentives that focus on proven strategies, such as 13 smoking cessation, injury and accident prevention, reduction of alcohol 14 misuse, appropriate weight reduction, exercise, automobile and 15 motorcycle safety, blood cholesterol reduction, and nutrition 16 education; 17 (d) Utilization review procedures including, but not limited to a 18 cost-efficient method for prior authorization of services, hospital 19 inpatient length of stay review, requirements for use of outpatient 20 surgeries and second opinions for surgeries, review of invoices or 21 claims submitted by service providers, and performance audit of 22 providers; 23 (e) Effective coordination of benefits; 24 (f) Minimum standards for insuring entities; and 25 (g) Minimum scope and content of public employee benefit plans to 26 be offered to enrollees participating in the employee health benefit 27 plans. To maintain the comprehensive nature of employee health care 28 benefits, employee eligibility criteria related to the number of hours 29 worked and the benefits provided to employees shall be substantially 30 equivalent to the state employees' health benefits plan and eligibility 31 criteria in effect on January 1, Nothing in this subsection 32 (2)(g) shall prohibit changes or increases in employee point-of-service 33 payments or employee premium payments for benefits or the 34 administration of a high deductible health plan in conjunction with a 35 health savings account. 36 (3) The board shall design benefits and determine the terms and 37 conditions of employee and retired employee participation and coverage, 38 including establishment of eligibility criteria. The same terms and SHB 2098 p. 16

17 1 conditions of participation and coverage, including eligibility 2 criteria, shall apply to state employees and to school district 3 employees and educational service district employees. 4 (4) The board may authorize premium contributions for an employee 5 and the employee's dependents in a manner that encourages the use of 6 cost-efficient managed health care systems. During the fiscal biennium, the board may only authorize premium contributions for 8 an employee and the employee's dependents that are the same, regardless 9 of an employee's status as represented or nonrepresented by a 10 collective bargaining unit under the personnel system reform act of The board shall require participating school district and 12 educational service district employees to pay at least the same 13 employee premiums by plan and family size as state employees pay. 14 (5) The board shall develop a health savings account option for 15 employees that conform to section 223, Part VII of subchapter B of 16 chapter 1 of the internal revenue code of The board shall comply 17 with all applicable federal standards related to the establishment of 18 health savings accounts. 19 (6) Notwithstanding any other provision of this chapter, the board 20 shall develop a high deductible health plan to be offered in 21 conjunction with a health savings account developed under subsection 22 (5) of this section. 23 (7) Employees shall choose participation in one of the health care 24 benefit plans developed by the board and may be permitted to waive 25 coverage under terms and conditions established by the board. 26 (8) The board shall review plans proposed by insuring entities that 27 desire to offer property insurance and/or accident and casualty 28 insurance to state employees through payroll deduction. The board may 29 approve any such plan for payroll deduction by insuring entities 30 holding a valid certificate of authority in the state of Washington and 31 which the board determines to be in the best interests of employees and 32 the state. The board shall promulgate rules setting forth criteria by 33 which it shall evaluate the plans. 34 (9) Before January 1, 1998, the public employees' benefits board 35 shall make available one or more fully insured long-term care insurance 36 plans that comply with the requirements of chapter RCW. Such 37 programs shall be made available to eligible employees, retired 38 employees, and retired school employees as well as eligible dependents p. 17 SHB 2098

18 1 which, for the purpose of this section, includes the parents of the 2 employee or retiree and the parents of the spouse of the employee or 3 retiree. Employees of local governments and employees of political 4 subdivisions not otherwise enrolled in the public employees' benefits 5 board sponsored medical programs may enroll under terms and conditions 6 established by the administrator, if it does not jeopardize the 7 financial viability of the public employees' benefits board's long-term 8 care offering. 9 (a) Participation of eligible employees or retired employees and 10 retired school employees in any long-term care insurance plan made 11 available by the public employees' benefits board is voluntary and 12 shall not be subject to binding arbitration under chapter RCW. 13 Participation is subject to reasonable underwriting guidelines and 14 eligibility rules established by the public employees' benefits board 15 and the health care authority. 16 (b) The employee, retired employee, and retired school employee are 17 solely responsible for the payment of the premium rates developed by 18 the health care authority. The health care authority is authorized to 19 charge a reasonable administrative fee in addition to the premium 20 charged by the long-term care insurer, which shall include the health 21 care authority's cost of administration, marketing, and consumer 22 education materials prepared by the health care authority and the 23 office of the insurance commissioner. 24 (c) To the extent administratively possible, the state shall 25 establish an automatic payroll or pension deduction system for the 26 payment of the long-term care insurance premiums. 27 (d) The public employees' benefits board and the health care 28 authority shall establish a technical advisory committee to provide 29 advice in the development of the benefit design and establishment of 30 underwriting guidelines and eligibility rules. The committee shall 31 also advise the board and authority on effective and cost-effective 32 ways to market and distribute the long-term care product. The 33 technical advisory committee shall be comprised, at a minimum, of 34 representatives of the office of the insurance commissioner, providers 35 of long-term care services, licensed insurance agents with expertise in 36 long-term care insurance, employees, retired employees, retired school 37 employees, and other interested parties determined to be appropriate by 38 the board. SHB 2098 p. 18

19 1 (e) The health care authority shall offer employees, retired 2 employees, and retired school employees the option of purchasing long- 3 term care insurance through licensed agents or brokers appointed by the 4 long-term care insurer. The authority, in consultation with the public 5 employees' benefits board, shall establish marketing procedures and may 6 consider all premium components as a part of the contract negotiations 7 with the long-term care insurer. 8 (f) In developing the long-term care insurance benefit designs, the 9 public employees' benefits board shall include an alternative plan of 10 care benefit, including adult day services, as approved by the office 11 of the insurance commissioner. 12 (g) The health care authority, with the cooperation of the office 13 of the insurance commissioner, shall develop a consumer education 14 program for the eligible employees, retired employees, and retired 15 school employees designed to provide education on the potential need 16 for long-term care, methods of financing long-term care, and the 17 availability of long-term care insurance products including the 18 products offered by the board. 19 (h) By December 1998, the health care authority, in consultation 20 with the public employees' benefits board, shall submit a report to the 21 appropriate committees of the legislature, including an analysis of the 22 marketing and distribution of the long-term care insurance provided 23 under this section. 24 (10) The health savings account option for employees under 25 subsection (5) of this section shall be offered to employees during the 26 open enrollment period in NEW SECTION. Sec. 21. Subheadings used in this act are not any 28 part of the law. 29 NEW SECTION. Sec. 22. Sections 10 through 14 of this act take 30 effect January 1, END --- p. 19 SHB 2098